Chronic Pain

Chronic pain is pain that persists long beyond the usual healing time for an injury. Chronic pain can manifest in a multitude of ways including sciatica, pain from herniated discs, whiplash disorder, RSI, carpal tunnel syndrome, tennis and golfer's elbow, frozen shoulder, restricted range of motion in the shoulder joint, sporting overuse injuries such as Achilles tendinitis, rheumatoid and osteoarthritis, TMJ pain, heads/migraines, fibromyalgia, IBS and chronic fatigue syndrome. Chronic pain can also manifest as mysterious pain which is persistent and debilitating but has no diagnosis, despite extensive medical tests.

People with long-term chronic pain are rarely able to find relief via orthodox medical routes, which leaves a lot of people in pain, frustrated, depressed and unable to live life as they would wish too. The orthodox medical profession is rarely equipped to deal with chronic pain, as the single most important factor in treating it is TIME. Research undertaken over the last few decades has increasingly shown that chronic pain is a complex and multi-factorial phenomenon:

“The subjective experience of pain is not just due to the tissue damage but heavily influenced by physiological and social factors” Fairweather and Mari 2016, 34

To put it another way, there is a strong and real connection between the mind and the body when it comes to pain and our perceptions of pain. Tissue damage may be present in all cases of chronic pain, but pain-related beliefs (i.e. being frightened to move as it may cause more pain), your emotional state, stress-levels, and your overall health all play a role in our perception and experience of the pain.

The French philosopher Descartes suggested that the mind and body were distinct and separate entities, and Western views on pain have been heavily influenced by these ideas. Eastern philosophy however, rejects this dualistic view of pain, preferring to see the mind and body as inseparable. Research into the functions of the brain over the last two decades have increasingly shown its strong influence over our experience of pain, supporting the Eastern view that the mind and the body are inseparable. Research has shown that there is no correlation between the amount of pain you feel and the amount of tissue damage sustained, furthermore, you can be tissue damage without pain and pain without tissue damage.

So if pain isn't always coming from the tissues, where is it coming from? Here we must delve into the world of nociceptors - receptors in tissues which can detect damage or inflammation. One model of pain states that the brain always interprets nociceptor stimulation as pain and because pain = danger, the brain must take action to try to get rid of the pain e.g. remove sharp object from your foot, go to hospital. In this system the response to pain is bottom-up, in that the tissues send messages to the brain flagging that there is damage, and the brain then duly interprets the sensation as pain.

This all seems quite logical, because you would indeed respond pretty quickly to a sharp object in your foot, but pain research over the last few decades has shown that there is not a simplistic relationship between nociception and pain, because the tissues of the body are sensitive to all kinds of stimuli. To understand this better pop over here and watch a great TED talk by Lorimer Moseley on pain and nociceptors.

Research by Moseley and Melzack has shown that the brain plays a massive role in the creation of pain. This means that pain is not just a passively perceived as a sensation, but a response to multiple inputs which produce an output of pain. The neuromatrix (Melzack 1999) is a model for understanding pain in which there is more emphasis on messages running down from the brain rather than just up from the tissues. In this model, the brain interprets multiple stimuli, including memories and past experiences, in its decision to interpret a sensation as pain or not.

So what happens when pain persists even when an injury has healed? This phenomenon is known as sensitisation.

Peripheral sensitisation is when the nociceptors in the tissues and peripheral nerves respond to a stimuli, e.g. inflammation. This can be very useful directly after an injury because feeling more sensitive enables us to protect the area that is hurt from further damage.

Central sensitisation is when the central nervous system (the brain and spinal cord) 'change, distort or amplify the experience of pain in a manner that no longer reflects the noxious stimuli from the periphery' (Lederman 2013, 127). In order words, the brain and the spinal cord act like an amplifier, turning up the volume on pain even though there is no real injury or damage. This is the main feature of many of the chronic pain conditions that I mentioned in the first paragraph of this post.

The good news is that it is possible to change the sensitivity of the nervous system. The life of a sensor is short, which means that you always have the opportunity to take control and affect what is going on. The great news is that massage and bodywork can help to reduce peripheral and central sensitisation. And further more, because of the mind/body connection, massage can also bring positive benefits to the emotional/intellectual sides of chronic pain, putting sufferers back in touch with their bodies, and enabling them to move towards a place where they are no longer in pain.

References
Lederman, E. (2013) Therapeutic Stretching: Towards a Functional Approach. Churchill Livingstone Elsevier.
Melzack, R. (1999) From the gate to the neuromatrix. Pain. (supplement 6): S121-126
Fairweather, R. and Mari, M. S. (2016) 'Chronic pain', in Massage Fusion. The Jing method for the treatment of chronic pain, pp 33-51. Handspring Publishing, Edinburgh.
Lorimer Moseley, 'Why things hurt', TED Talk https://www.youtube.com/watch?v=gwd-wLdIHjs&t=45s